Imaging for suspected appendicitis.

Abstract

Acute appendicitis is the most common reason for emergency abdominal surgery and must be distinguished from other causes of abdominal pain. Family physicians play a valuable role in the early diagnosis and management of this condition. However, the overall diagnostic accuracy achieved by traditional history, physical examination, and laboratory tests has been approximately 80 percent. The ease and accuracy of diagnosis varies by the patient's sex and age, and is more difficult in women of childbearing age, children, and elderly persons. If th diagnosis of acute appendicitis is clear from the history and physical examination, prompt surgical referral is warranted. In atypical cases, ultrasonography and computed tomography (CT) may help lower the rate of false-negative appendicitis diagnoses, reduce morbidity from perforation, and lower hospital expenses. Ultrasonography is safe and readily available, with accuracy rates between 71 and 97 percent, although it is highly operator dependent and difficult in patients with a large body habitus. While there is controversy regarding the use of contrast media and which CT technique is best, the accuracy rate of CT scanning is between 93 and 98 percent. Disadvantages of CT include radiation exposure, cost, and possible complications from contrast media.